The exacting schedule of a surgeon is evident at the outset of a Zoom interview with Dr. SreyRam Kuy (Microbiology, ’00). She is a little late for the midday appointment because she had to shower first. Just 30 minutes earlier, Kuy “was elbow deep in blood and stool” performing a colon cancer surgery. An epidemic is engulfing the country, but there are other undeniably urgent healthcare crises that beset everyday Americans. “Even in the middle of Covid-19, we get patients with perforated colon cancers and we have to conduct emergency surgery,” said Kuy. The busy week saw her covering general surgery and surgical oncology patients.
While her hospital, like others in the country, has postponed all non-emergency surgeries under the onslaught of the Covid-19 epidemic, Kuy and her colleagues continue to tackle surgeries in life-and-death situations.
It is hard to believe there was a time when Kuy felt terrified by the sight of blood. She wanted to be a family doctor when she arrived at Oregon Health and Science University (OHSU) to study medicine. But an oncology surgical rotation where she got to assist on a colon cancer operation for the first time changed her outlook and put her on the path toward specializing in surgery.
Today Kuy is a general surgeon at the Veterans Affairs (VA) Medical center in Houston. She is the deputy chief medical officer for quality and safety of the South Central Veteran Affairs Healthcare Network, where she works on improving patient safety and patient care for veterans. She is also a professor at the Baylor College of Medicine.
Kuy previously served as special advisor to the Secretary of Veterans Affairs in Washington, D.C., and was the first woman appointed deputy undersecretary for community care, overseeing a $14.5 billion budget and 7,300 staff.
Getting prepared for a crisis
No stranger to prestigious honors, Kuy was one of 21 senior healthcare leaders selected nationally for a two-year fellowship with the Aspen Institute Health Innovators program in 2019. The fellows commit to launching a leadership venture with lasting, transformative impact on the health of Americans and the healthcare system. In her role as a Health Innovators Fellow, Kuy developed a Covid-19 Preparation Tool to help healthcare facilities, businesses and communities rapidly gauge their preparedness for the outbreak, identify areas of weakness and strategically target resources for their greatest impact.
She worked over a period of six months to create leadership toolkits designed to tackle “a series of health crises, including natural disasters, infectious pandemics and upsurges in medical errors.” When the Covid-19 outbreak was declared a full-blown pandemic, Kuy was prepared. “As news of a novel coronavirus outbreak emerged in January, I realized that it was only a matter of time before Covid-19 became a global crisis,” Kuy remarked.
Kuy has partnered with healthcare company Get Well Network to widely deploy and share the tool nationally with organizations. The completely free, rapid (the survey questionnaire takes 2-3 minutes to complete) and easily accessible Covid-19 toolkit comes in two versions for healthcare systems and businesses. It is based on Centers for Disease Control (CDC) guidance and resources and provides immediate feedback to users.
"I have learned that this crisis is like being in the fog of war. You don't have time to go and read 50 pages of resources that some technical expert wrote on that issue,” said Kuy. “At that moment, you need something that's clear, decisive, and very short and to the point that helps leaders get that information in a fast, rapid way that can help them identify the strategies they need to adopt.” While Kuy’s own workplace is highly advanced in terms of crisis management, she hopes her blueprint will help organizations that are less well prepared to deal with the stress of the pandemic and continue to stay functional.
By now, Kuy has had plenty of experience at effective and transformational leadership during public health emergencies. She was the chief medical officer for Medicare in Louisiana — one of the poorest states of America, ranking very low for health outcomes and access to health care. In that role, Kuy worked through emergencies that included floods, the opioid epidemic and the Zika outbreak. She was overseeing a $10.7 billion system covering 1.6 million children, pregnant women and disabled and indigent patients, when the Great Flood hit the state in 2016. “Our skeleton crew worked around-the-clock to ensure that patients who were pregnant, young, disabled, and/or low-income could access prescription medications lost in the flood, find replacements for damaged wheelchairs and ventilators, and receive vital tetanus shots and mold precautions—all while working to improve quality and outcomes in the day-to-day operations,” writes Kuy.
Making a difference, inside and outside the operating room
A prominent surgeon, healthcare executive, writer, scholar and academic, Kuy has distinguished herself as a multifaceted doctor making a difference inside and outside operating rooms. She is a surgeon who has also blazed a trail in healthcare management holding key leadership positions in complex health systems.
Kuy was attracted to a policy role because she felt she could have a bigger impact on healthcare at both regional and national levels. “You are in a position to change millions of lives. In Louisiana, I was overseeing care of more than a million patients. When I was deputy undersecretary in Washington, D.C., we were taking care of 9 million veterans who are in some way impacted by the VA.”
One may imagine that one job overshadows the other, but Kuy has found firm footing in both.
Always a doctor at heart, Kuy has not strayed from medicine as a healthcare executive. In Louisiana, she performed the gamut of surgeries on breast cancers to gallbladder and hernia operations once a week for uninsured or underinsured patients. She would fly home to Houston from her job in D.C. to conduct surgeries on veterans.
“It’s critically important if you are going to be a leader or executive in healthcare to stay on the frontlines so that you know what is going on,” she said. Working as a surgeon in Louisiana helped her see that young medical residents were not aware of the problem of over-prescription of opioids in the state. “I realized we need to do a better job at messaging. And that’s one of the benefits of being on the frontline; you get to see the effect of the policies you make,” said Kuy. “Plus, I just love operating and taking care of patients. That’s what brings me joy.”
Kuy is credited with drastically limiting opioid prescriptions and leading bold, new initiatives to mitigate the opioid crisis in Louisiana. With high numbers of opioid overdose deaths stemming largely from one of the highest opioid prescription rates in the country, Louisiana needed vast public health overhauls and reforms when Kuy took charge.
“I shared data drilled down to Louisiana parishes (counties) with legislators to show them that the deaths from opioid overdoses exceeded the deaths from homicides,” Kuy said.
Working within the scope of CDC guidelines, Kuy battled stiff opposition to enact Medicaid policies curtailing opioid prescriptions, thus overturning a longstanding physician practice of prescribing medications for 30 days to allowing just a week of pain medications for acute pain. She encouraged doctors to look for alternative therapies and non-opioid medications to manage acute and chronic pain in patients.
Among other things, Kuy developed a statewide naloxone standing order to empower individuals to intervene during an overdose, implemented Medicaid opioid policies, supported the creation and successful passage of legislation limiting opioid prescriptions, and developed educational webinars, symposiums and a website to assist patients and doctors. Her efforts bore results. Within a year, opioid prescriptions in Louisiana fell by 40% among Medicaid patients.
At the end of her term, Kuy changed hearts and minds. Three pieces of legislation passed with the vigorous support of some of her former biggest adversaries on the issue of opioid prescriptions.
Kuy graduated with dual degrees in microbiology and philosophy in 2000 from Oregon State University. She received her medical degree from OHSU in Portland and completed her residency in general surgery at the University of Texas Health Science Center at San Antonio and at the Medical College of Wisconsin, Milwaukee. Kuy also earned a master’s degree in health science at Yale University School of Medicine, where she completed a fellowship with the Robert Wood Johnson Clinical Scholars Program.
Despite her busy life, Kuy recently made time to host a seminar on her work in health policy via Zoom with OSU Honors College students. “I am so impressed by these brilliant, inquisitive minds. The future is bright and gives me hope!” Kuy said.
From Cambodia to Corvallis and beyond
Kuy’s extraordinary story about finding her path towards medicine from her early days in a Cambodian death camp has been recounted many times, but it is one that bears repeating. Born in captivity, Kuy, her parents and her older sister survived the brutal Khmer Rouge regime in Cambodia, and after it ended, the Kuy family settled into a refugee camp in Thailand. There Kuy, her sister SreyReath and their mother were severely injured by a grenade attack. A Red Cross surgeon performed lifesaving operations on Kuy and her mother. Her sister who suffered shrapnel injuries did not require surgery.
“That inspired me to become a doctor. It was a long time ago, and I was really young when that happened. But it's a story that's part of the fiber of my being. And I've always known for as long as I can remember that I wanted to be a doctor,” Kuy said. She was also inspired throughout her life by her mother who kept reminding her children that they had to make the most of their lives because they had survived while countless others perished in Cambodia.
In 1981 after transferring to a refugee camp in the Philippines, the Kuy family arrived in faraway Corvallis via sponsorship by a Christian charity and made the verdant town their home. The years were difficult even though Kuy and her sister thrived academically. Her father had been a government official and her mother was a teacher in Cambodia before the Khmer Rouge regime took hold, but they didn’t have similar employment in America.
Her father worked as a janitor at OSU and her mother was a housekeeper in healthcare facilities. “My mother worked at Good Samaritan Hospital and a nursing home cleaning operating rooms, mopping floors and scrubbing toilets,” said Kuy. “I give my mother credit because she was willing to work hard at anything to give me and my sister a chance at a better life, at freedom and, more than that, a chance to live.”
A valedictorian at Crescent Valley High School, Kuy gained admission to Harvard, but she had lost her father to stomach cancer during her senior year and didn’t want to move away from her family. So, she joined OSU to study microbiology and philosophy. It is a decision that she has never regretted.
“I had such amazing support at OSU. My teachers and advisers took genuine interest in me and helped and encouraged me. It was a pivotal point in my life that helped me get into medical school and become a doctor,” Kuy remarked.
While microbiology helped her understand the mechanisms of health and disease, Kuy says her philosophy major equipped her to think critically about complicated health policy matters and communicate ideas. During her senior year, Kuy embarked on a transformative experience when she worked in Washington, D.C. at the U.S. Senate for the office of Senator Tom Harkin, the chief architect of the Americans with Disabilities Act of 1990. There Kuy started paving her way to her future career in health policy by drafting memos and speeches about women’s health and advocating for the passage of the Breast and Cervical Cancer Prevention and Treatment Act.
Kuy and her sister SreyReath, who is a podiatrist in Texas, authored a book on their experiences in Cambodia, The Heart of a Tiger. Kuy has published articles in Huffington Post, Los Angeles Times and the Washington Post on her experiences as a survivor of genocide and the first female Cambodian refugee to work as a surgeon in the U.S. As a Robert Wood Johnson Foundation Clinical Scholar at Yale University, she wrote the landmark book, 50 Studies Every Surgeon Should Know, published by Oxford University Press.
She has won a number of awards and honors celebrating her work with vulnerable and underserved populations that include veterans and women on Medicaid. To name just a few, she has received President George H.W. Bush’s Daily Points of Light Award, American College of Surgeons “Mary Edwards Walker Inspiring Women in Surgery Award” and the OHSU School of Medicine Alumni Early Career Achievement Award. She is a Fellow of the American College of Surgeons and was selected to the Presidential Leadership Scholars Program in 2017, a partnership among the presidential centers of Lyndon B. Johnson, George H.W. Bush, Bill Clinton, and George W. Bush that brings together mid-career leaders from diverse backgrounds.
Kuy is thankful for the incredibly dedicated professors who taught her at OSU. “My professors at OSU didn’t just teach; they inspired, encouraged and supported me in my dreams. I am truly grateful for the mentors at OSU who guided me in my journey.”